Patients with rheumatoid arthritis have a higher prevalence of cardiovascular disease than the general population. However, according to a press release from EULAR, the risk of acute coronary syndromes may be reduced in patients who achieve remission after receiving disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or tumor necrosis factor (TNF) inhibitors. The findings from three new studies were presented by Delcoigne et al, Buch et al, and Aymon et al at the EULAR 2023 Congress and simultaneously published in the Annals of the Rheumatic Diseases.
In the first study, researchers analyzed the patient outcomes from 14,488 courses of methotrexate and 13,056 courses of TNF inhibitors from 2012 to 2021. The researchers found that 40% and 32% of patients who received methotrexate and TNF inhibitors, respectively, achieved remission. After 1 year of follow-up, they compared the incidence rates of acute coronary syndromes for those treated with DMARDs compared with those in the general population and discovered that patients who received methotrexate experienced incidence rates of 3.4 per 1,000 person-years vs 3.8 per 1,000 person-years for those who received TNF inhibitors. Further, comparing incidence rates among those treated with DMARDs with the general population yielded a hazard ratio of 1.08.
In the second study, researchers evaluated whether cardiovascular comorbidities could impact treatment efficacy in 4,362 patients with rheumatoid arthritis and either a history or no history of atherosclerosis. The researchers demonstrated that the efficacy of tofacitinib vs TNF inhibitors was comparable for those with and without a history of atherosclerosis; however, patients who had intermediate to high cardiovascular risk scores or low-borderline risk scores were found to be more likely to achieve remission with tofacitinib.
In the third study, researchers found no significant differences in the risk of major adverse cardiac events among patients with rheumatoid arthritis taking Janus kinase inhibitors compared with those taking TNF inhibitors. The researchers hope to expand their analyses to the risks of thromboembolic events, cancer, and infections in future studies.